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Background Gastro-cutaneous fistula is a rare complication after laparoscopic sleeve gastrectomy (LSG) with incidence of occurrence 1–2%. Most of gastro-cutaneous fistulae do not respond to conservative management and need intervention either surgically or endoscopically. Methods This prospective randomized clinical study included referred patients who had LSG performed at our department or other centers, and complicated with post-LSG leak or gastro-cutaneous fistula between December/2019 and March/2021. Included patients were ASA Physical status I–II. Primary and secondary outcomes were recurrence of the fistula and mortality in each group after the intervention during the 18 months follow-up period, respectively. Results Thirty patients were randomized into two groups: Surgery Group (SG, n = 15) and Endoscopy Group (EG, n = 15). Mean age of patients was 42.3 ± 8.7 and 42.6 ± 8.3 years-old in SG and EG, respectively. Females constituted 73.3% and 80% in SG and EG, respectively. Median time-to-gastric leak post LSG was six (range: 4–7) days in both groups. SG patients were surgically managed with primary repair of the gastric fistula and gastrojejunostomy in 13 patients or converting SG into Roux-en-Y gastric bypass in two patients, while EG patients were endoscopically managed with stitching, stenting, stenting and dilation, and clipping and dilation in 5, 4, 4 and 2 patients, respectively. Incidence of recurrent leak during 1st week was significantly higher in SG than EG (p p = 0.48). Conclusion Endoscopic intervention may offer a successful modality in managing post-LSG gastric leak and gastro-cutaneous fistula that do not respond to conservative measures in stable patients.

Background Colonic anastomotic leak and fistula following anterior resection surgery for rectal cancer are associated with high mortality rates. The incidence of occurrence varies from 2 to 25% and it is difficult to accurately calculate the incidence of fistula and leak post anterior resection, as most of them are asymptomatic. Endoscopic management of fistula and leak has become the first line of management after conservative management in many gastrointestinal surgical centers with the advantages of being less invasive, shorter length of post-operative hospital stay, effective and rapid recovery in comparison to revision surgery. Effective endoscopic management for colonic fistula or leak depends on the clinical status of the patient and fistula characters (time-to-occur and size and site of defect), and device availability. Methods This prospective randomized controlled clinical trial included all patients who developed the manifestations of low output recurrent colonic fistula or leak after colonic anterior resection for rectal cancer at Zagazig University Hospital between (December 2020 and August 2022). Sample size was 78 patients divided into two equal groups. Endoscopic group (EG): included 39 patients who underwent endoscopic management. Surgical group (SG): included 39 patients who underwent surgical management. Results The investigators randomized eligible 78 patients into two groups: 39 patients in SG and 39 patients in EG. The median size of the fistula or leak was nine (range: 7–14) mm in EG, versus ten (range: 7–12) mm in SG. Clipping and Endo-stitch device were used in 24 patients versus 15 patients, respectively, in EG while primary repair with ileostomy, and resection & anastomosis were used in 15 patients versus 24 patients, respectively, in SG. Recurrence, abdominal collection, and mortality were the post procedure’s complications with incidence of occurrence of 10.3, 7.7 and 0%, respectively, in EG versus 20.5, 20.5 and 2.6%, respectively, in SG. Excellent, good, and poor were the parameters for quality of life with incidence of occurrence of 43.6, 54.6 and 0%, respectively, in EG versus 28.2, 33.3 and 38.5%, respectively, in SG. Median hospital stay was one (range: 1–2) day in endoscopic group, and seven (range: 6–8) days in SG. Conclusion Endoscopic intervention may offer a successful modality in managing low output recurrent colonic fistula or leak after anterior resection for rectal cancer that did not respond to conservative measures in stable patients. ClinicalTrials.gov ID: NCT05659446.

Background: Laparoscopic drainage of appendicular abscess has become a novel technique due to its advantages over interventional radiology like complete exploration of the abdomen, exclusion of other pathologies, excision of the appendix at same session, better cosmesis, decrease incidence of wound infection & incisional hernia, better visualization of surgical field, fine handling of edematous tissue and drainage of multiple collections. Methods: This prospective randomized controlled clinical trial included all patients who developed the manifestations of appendicular abscess and referred to the Zagazig University Hospital Emergency Department between January 2020 and February 2022. The study was prospectively approved by Zagazig University Faculty of Medicine Institutional Review Board (Approval Number: 55342/24.1.2020), and was retrospectively submitted in clinicaltrials.gov in 15/6/2022 (ClinicalTrials.gov ID: NCT05419440). The sample size was 172 patients divided into two equal group, laparoscopic group involved 86 patients (group1), interventional radiology group involved 86 patients (group2). Results: “Group 1 (laparoscopic drainage group) included 86 patients: 55.8% were males, with a mean age of 41.2 (± 12.2) years-old, while in group 2 (interventional radiology group) included 86 patients: 51.2% were males, with a mean age of 36.8 (± 10.9) years-old. The reported complications were bowel injury, fecal fistula, recurrence, pelvic collection and mortality with incidence rates of occurrence 1(1.2%), 3 (3.5%), 0 (0%), 0 (0%), 0(0%) respectively in group (1) while in group(2) were 5(5.8%), 0(0%), 3(3.5%), 8(9.3%), 1(1.2%) respectively. Regarding quality of life in both groups were excellent, good, poor with incidence rates of 48(55.8%), 38(44.2%), 0(0%) respectively in group (1), and 12(14%), 59(68.6%), 15(17.4%) respectively in group(2). Conclusion: Laparoscopic management of appendicular abscess can be safely applied in a good experienced hand with no mortality & morbidity, without the need for interval appendectomy.

Background: Laparoscopic drainage of appendicular abscess has become a novel technique due to its advantages over interventional & open surgery like complete exploration of the abdomen, exclusion of other pathologies, excision of the appendix at same session, better cosmoses, decrease incidence of wound infection & incisional hernia, better visualization of surgical field, fine handling of edematous tissue and drainage of multiple collections. Methods: This prospective randomized controlled clinical trial included all patients who developed the manifestations of appendicular abscess and referred to the Zagazig University Hospital Emergency Department between January 2020 and February 2022. The study was prospectively approved by Zagazig University Faculty of Medicine Institutional Review Board (Approval Number: 55342/24.1.2020), and was retrospectively submitted in clinicaltrials.gov in June 2022 (ClinicalTrials.gov ID: NCT05419440). The sample size was 172 patients divided into two equal group, laparoscopic group involved 86 patients (group1), interventional radiology group involved 86 patients (group2). Results: 172 patients divided into equal groups, group (1) laparoscopic drainage group included 86 patients, 48(55.8%) patients of them were male, 38 (44.2%) patients were female, with the age of the patients range from 16–60 years with median of the age (41.2 ± 12.2), group (2) interventional radiology group included 86 patients, 44 (51.2%) patients were male, 42 (48.8%) patients were female, with age range from 16–60 years, with the median of age (36.8 ± 10.9). The complications in both groups were bowel injury, fecal fistula, recurrence, pelvic collection and mortality with incidence of occurrence 1(1.2%), 3 (3.5%), 0 (0%), 0 (0%), 0(0%) respectively in group (1) while in group(2) were 5(5.8%), 0(0%), 3(3.5%), 8(9.3%), 1(1.2%) respectively. Regarding quality of life in both groups were excellent, good, poor with incidence of 48(55.8%), 38(44.2%), 0(0%) respectively in group (1), and 12(14%), 59(68.6%), 15(17.4%) respectively in group(2). Conclusion: Laparoscopic management of appendicular abscess can be safely applied in a good experienced hand with no mortality & morbidity, without the need for interval appendectomy.

Background : Peptic ulcer perforation is a common and life threatening surgical emergency. The traditional , pedical omental patch is performed for the plugging of perforated peptic ulcer was first described by Cellan-Jones in 1929. Although it is attributed to Graham , who described the use of a free graft of the omentum to repair the perforation in 1937. Many endoscopic methods have been used to treat acute perforated peptic ulcer like over the scope clips , standard endoscopic clips , endoscopic sewing and metallic stents. The main idea in endoscopic management of acute perforated peptic ulcer is early decontamination and decrease sepsis by interventional radiologic drainage.Methods:This study included patients who were developed acute perforated peptic ulcer manifestations and were admitted to our hospital between December 2019 to August 2021. Sample size was 100 patients divided into 2 equal groups. Endoscopic group (EG): included 50 patients who were subjected to endoscopic management . Surgical group (SG): included 50 patients who were subjected to surgical management.Results:Hundred patients were randomized into 2 groups: Surgery Group (SG, n=50) and Endoscopy Group (EG, n=50). Median age of patients was 36( range 27:54) and 47( range 41:50) years-old in SG and EG, respectively. Males constituted 72% and 66% in SG and EG, respectively. Median postoperative hospital stay was 1 (range: 1-2) days in EG , while in SG was 7 (range 6-8) days. Postoperative complications in SG patients were 58% in form of fever , pneumonia , leak , abdominal abcess , renal failure , incisional hernia, ( 11%, 5%, 5%, 3%, 2%, 3% , respectively). While postoperative complications in EG patients were 24% in form of fever , pneumonia , leak , abdominal abcess , renal failure , incisional hernia, ( 10%, 0%, 2%, 0%, 0%, 0% , respectively). Conclusion:combined endoscopic & interventional radiology can effectively manage acute perforated peptic ulcer without need for general anesthesia , within short time , in high risk surgical patients with low incidence of morbidity & mortality.This study was retrospectively submitted in clinicaltrials.gov in September 2021 (NCT05051683).

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